Final Report: Expanding How We Conceptualize and Measure Inequity in Family Planning

The concept of inequity in family planning has evolved over time, shifting from a focus on contraceptive uptake alone to a broader understanding of the programmatic components that affect use. These components include access to information and services, good quality of care, and other factors that impact the decision to use family planning services. The Health Policy Plus (HP+) project, funded by USAID, has developed a tool for identifying inequity in family planning programs. The Family Planning Equity Tool (FP Equity Tool) is designed to be applied in any country with a Demographic and Health Survey. The tool identifies inequities in family planning for a range of commonly disadvantaged subgroups, various components of family planning programming, and at the national level and across and within each subnational area. The FP Equity Tool works by running a series of statistical computations for the user, examining the experience of seven commonly disadvantaged groups in five dimensions of family planning programming at national and subnational levels. The tool generates findings automatically in Microsoft Excel, complete with signposts to help the user interpret the results, and accompanying maps and charts to easily visualize inequities. This level of specificity is key to guiding national and subnational decision making on family planning beyond 2020. The application of the FP Equity Tool in Uganda revealed pervasive family planning inequities that affect a broad range of underserved groups, extend beyond traditional measures of uptake, and penetrate all regions. The analysis showed that least-educated and unmarried women, in addition to the youngest, are some of the most disadvantaged. This finding highlights the need to channel services to a diversity of women, rather than relying solely on traditional equity analyses focused on use and wealth quintile. The FP Equity Tool has the potential to make a significant impact in the coming decade by helping decision-makers and program staff choose which components to prioritize and where. By identifying inequities in family planning and providing a framework for addressing them, the tool can help prevent women and girls from being left behind. The tool is an important initial step on the road to eliminating unjust conditions and is part of a broader effort to achieve universal access to reproductive health services. The FP2030 partnership, which builds on the progress made during the FP2020 initiative, will require a more nuanced understanding of inequity in family planning. The FP Equity Tool is well-positioned to support this effort by providing a dynamic and adaptable framework for identifying and addressing inequities in family planning programs. By leveraging the tool's capabilities, decision-makers and program staff can make more informed decisions about how to allocate resources and prioritize program activities, ultimately leading to better health outcomes for women and girls.